A new report from the US Surgeon General says e-cigarette use among youth and young adults has risen to the level of a public health concern. According to the report, electronic cigarette use has grown 900% among high school students from 2011 to 2015. In 2015, about 1 in 6 high school students used e-cigarettes in the past 30 days. The report is the first comprehensive federal review of the public health impact of e-cigarettes on American young people.

Surgeon General Vivek Murthy said, “Nicotine-containing products in any form, including e-cigarettes, are not safe. As Surgeon General, and a new father, I’m urging all Americans to take a stand against e-cigarette use by young people.”

The report uses the term “e-cigarette” to refer to all the different products that deliver nicotine electronically. Consumers and marketers call them by many names including “e-cigarettes,” “e-cigs,” “cigalikes,” “e-hookahs,” “mods,” “vape pens,” “vapes,” and “tank systems.” Most e-cigarettes contain nicotine, which can cause addiction and can harm the still-developing young brain.

While nicotine is highly addictive at any age, it is especially dangerous for youth and young adults. The harmful effects include reduced impulse control, lowered ability to learn and pay attention, increased mood disorders, and higher risk of addiction to other forms of tobacco and drugs.

Key messages:

E-cigarettes are now the most commonly used tobacco product among young people.

The aerosol from e-cigarettes often contains nicotine and other harmful ingredients, which is unsafe for the user and those who breathe it in secondhand.

Research has shown that youth who use e-cigarettes are more likely to go on to use other tobacco products such as regular cigarettes.

In 2015, more than ¼ of middle and high school students said they’d tried e-cigarettes.

As of 2014, more than ⅓ of young adults had tried e-cigarettes.

Brain development continues into the early to mid-20s. Nicotine exposure can harm the developing brain.

Exposure to nicotine by pregnant women, including secondhand exposure to the aerosols from e-cigarettes, can harm a developing fetus.

In 2014, more than 7 of 10 middle and high school students said they’d seen e-cigarette advertising.

According to the Surgeon General’s report, e-cigarette marketers use strategies that target young people. These include celebrity endorsements, sponsorships of music and sports events, themes of rebellion and sex, and widespread media advertising. The most frequent place to see advertising were retail stores, the internet, TV and movies, and magazines and newspapers. In 2012, the Surgeon General concluded that this type of advertising does cause young people to start using tobacco products.

Tobacco products may not be sold to anyone under 18, in person or online

Photo ID will be required to verify age

Free samples may not be distributed

Sales of tobacco products covered by the rule may not be sold in vending machines unless they are in an adult-only facility.

The Surgeon General’s Report also calls on parents, teachers, health providers, the government, and communities to protect young people from the harmful effects of e-cigarettes by treating them as seriously as regular cigarettes. According to the report:

Parents and educators should talk to youth about the harmful effects of all tobacco products and discourage their use.

Doctors and other health care providers should ask their young patients whether they use tobacco and talk to them about the harmful effects of nicotine on their brain.

Governments should pass clean indoor air laws that include e-cigarettes.

Communities and organizations should work to restrict e-cigarette and other tobacco advertising and implement anti-e-cigarette and anti-tobacco media campaigns.

Cliff Douglas, the American Cancer Society’s Vice President for Tobacco Control and Director of the Society’s Center for Tobacco Control said, “The American Cancer Society will continue to work hard to better educate the public – including kids, their parents, teachers, health providers, the media, and all decision makers about the scientific reality that these products are dangerous to youth and that youth must be protected.”

Learn more

Get help quitting tobacco for yourself or for someone you know. Call the American Cancer Society at 800-227-2345 or read our Guide to Quitting Smoking to access our many tools and tips to help smokers beat the urge to smoke and to help nonsmokers encourage loved ones to quit.

Citation: E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General—Executive Summary. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2016. Atlanta, Ga.

People who smoke as little as 1 cigarette a day over their lifetime still have a greater risk of early death than people who have never smoked, according to a study by researchers from the National Cancer Institute. The researchers say this shows that no level of cigarette smoking is safe.

The study included 290,215 adults ages 59 to 82 who answered questions about how many cigarettes they smoked during different periods throughout their lives. Researchers then followed the participants for an average 6.6 years. Results showed that people who consistently smoked an average of less than 1 cigarette per day had a 64% higher risk of dying earlier than people who had never smoked. Those who smoked 1 to 10 cigarettes a day had an 87% higher risk of dying earlier than people who never smoked. The risks were lower among former smokers compared to those who still smoked. And among former smokers, the earlier people quit, the lower their risk.

Results showed an especially strong link among study participants between cigarette smoking and death from lung cancer. People who consistently smoked an average of less than 1 cigarette per day had 9 times the risk of dying from lung cancer as people who had never smoked. Those who smoked 1 to 10 cigarettes a day had 12 times the risk of dying from lung cancer as people who never smoked, as well as significantly higher risks of death from respiratory and cardiovascular diseases.

According to Cliff Douglas, the American Cancer Society’s Vice President for Tobacco Control and Director of the Society’s Center for Tobacco Control, the difference between not smoking at all and smoking just a little bit is dramatic. He says, “It may be easy to rationalize smoking a few cigarettes a day if you’re not educated about the relative risks, but the risk of cancer and other debilitating and life-threatening illnesses are still significant even with ‘low-intensity’ smoking.”

More than lung cancer; more than cigarettes

In addition to lung cancer, smoking causes many other types of cancer and increases the risk of debilitating long-term lung diseases like emphysema and chronic bronchitis. It also raises the risk for heart attack, stroke, blood vessel diseases, and eye diseases. Half of all smokers who keep smoking will eventually die from a smoking-related illness.

The National Cancer Institute study examined only low levels of cigarette smoking. But use of other tobacco products has increased in recent years. These include cigars, pipes, hookahs, and electronic cigarettes (e-cigarettes). Just as there is no safe level of smoking, there is also no safe form of tobacco, including e-cigarettes.

The study’s authors call for future research examining the risks of low-level cigarette smoking combined with the use of other tobacco products, including e-cigarettes. The study was published online December 5, 2016 in JAMA Internal Medicine.

Citation: Association of Long-term, Low-Intensity Smoking With All-Cause and Cause-Specific Mortality in the National Institutes of Health–AARP Diet and Health Study. Published online December 5, 2016 in JAMA Internal Medicine. First author Maki Inoue-Choi, PhD, MS, National Cancer Institute, Rockville, Md.

The book contains 120 creative, delicious, healthy recipes with lots of variety – from familiar flavors to dishes with international influences. There’s an emphasis on vegetarian dishes, lean proteins, and fresh fruits and vegetables, including recipes such as Portobello and Poblano Tacos; Rice Noodles with Shrimp, Bok Choy, and Mint; Seafood and Shellfish Stew; and Chicken Paillard with Arugula and Fennel. Readers can enjoy tempting and flavorful low-calorie desserts, such as Roasted Pineapple with Toasted Coconut and Dark Chocolate Sorbet. The American Cancer Society’s nutritional staff has reviewed each recipe to ensure it is in keeping with recommended nutrition guidelines.

In addition to the recipes, this book is filled with practical tips and tools for improving overall health. “Steps to Loving Exercise” shows that exercise doesn’t have to be a chore, and other features show how small changes may result in big rewards when you know how to make good menu choices when dining out, how to practice portion control, how to read nutrition labels, how to stock a pantry, and more.

Written by best-selling cookbook author Jeanne Besser and reviewed by the trusted nutrition and medical experts at the American Cancer Society, this cookbook represents the latest in scientific evidence about diet, exercise, and health. The book also contains stunning, full-color photography and nutritional analysis for every recipe.

This book in one sentence: Offering 120 tantalizing new recipes, this cookbook will help readers create a healthy diet for life, as well as make small, sustainable lifestyle changes to improve their overall health.

Who needs this book: This book is for individuals, families, and anyone who wants to include healthier food choices in their everyday lives and create a well-rounded approach to healthier living.

In a saucepan, bring the broth to a simmer. Cover and keep warm over low heat (you can also microwave the broth).

In a large stockpot over medium heat, add 1 tablespoon of the oil. Sauté the onion for 2 to 3 minutes. Add the garlic and sauté for 1 minute. Add the rice and sauté for 1 minute. Add the wine and stir until it is almost completely absorbed.

Begin slowly adding the broth, 1⁄2 cup at a time, stirring frequently. Wait until the liquid is almost completely absorbed before adding more, 2 to 4 minutes. Continue to add the broth, stirring frequently for 20 to 30 minutes, or until the risotto has a creamy texture but is still al dente (just firm). You may not need to use all of the broth.

Meanwhile, in a skillet over medium-high heat, add the remaining 1 tablespoon of oil. Sauté the mushrooms for 3 to 5 minutes, or until they have softened and released their liquid.

When the risotto is ready, stir in the spinach until wilted. Add the mushrooms, thyme, and cheese, and stir to combine. Season with salt and pepper and serve.

The US government is making public housing smoke-free. Housing and Urban Development (HUD) Secretary Julian Castro announced that all public housing developments will be required to implement smoke-free policies within the next 18 months. The ban includes cigarettes, cigars, pipes, and hookahs in all living units, indoor common areas, administrative offices, and within 25 feet of all buildings. More than 2 million people, including 760,000 children, live in more than 3,100 public housing developments in the United States.

This new rule is intended to protect people from the harmful effects of secondhand smoke. According to HUD, secondhand smoke can travel into an apartment from other rooms in the building through doorways, cracks, electrical lines, ventilation systems, and plumbing. Opening windows, blowing fans, and running ventilation systems does not eliminate secondhand smoke.

“In addition to protecting millions of our fellow citizens from poisonous second-hand tobacco smoke, the new policy will encourage many residents to quit, as so many already wish to do,”said Cliff Douglas, the American Cancer Society’s Vice President for Tobacco Control and Director of the Society’s Center for Tobacco Control.

Secondhand smoke is harmful because it causes non-smokers, as well as smokers, to breathe in nicotine and toxic chemicals that is exhaled by smokers. Just like smoking, it causes lung cancer and is linked to other cancer types and other diseases. There is no safe level of exposure to secondhand smoke.

Many housing agencies already ban smoking and enforce the rules through warnings, fines, and education that includes counseling and quit-smoking aids. Castro has said he is confident that public housing staff can work with residents to help them stop smoking.

The American Cancer Society is dedicated to helping people who want to quit smoking do so successfully. Call us at 1-800-227-2345 to find out how we can help you or someone you know stay away from tobacco.

Pack healthy snacks. Take a cooler on family car trips, and include healthy snacks such as hummus and carrots, sliced apples and peanut butter, and string cheese with whole-grain crackers. If a cooler is not an option, stock pretzels, nuts, and home-made trail mix.

Lighten up fast food. You can eat at convenient fast-food restaurants without blowing your diet. Skip fried foods, bacon, cheese, and heavy sauces, and choose grilled chicken, vegetables, and salads, but without lots of cheese and dressing.

Exercise. On long car trips, use rest-stop breaks to take walks, run laps, play tag, or do stretches or push-ups. Explore the airport terminal during a long flight layover. At your destination, take advantage of hotel pools and gyms, exercise in your room each day, or explore your new surroundings on foot.

Take control. Don’t be afraid to ask for food to be prepared the way you want it in a restaurant. Order dressings and sauces on the side, ask for half portions, or share a full one. Make smart substitutions, like vegetables or salad for fries. And shop at the supermarket for some of your meals. Many supermarkets have prepared low-fat meal options such as boxed salads and rotisserie chickens.

Party with a plan. If your plans involve holiday parties or family celebrations, snack on healthy foods beforehand, so you’re not starving when you get to the event. When you do arrive, drink a glass of water and mingle with the other guests before heading for the food. Fill most of your plate with fruits and vegetables, leaving just a small space for that special treat. Then, turn your back to the buffet table and focus on having fun, not having food. Don’t forget to go easy on the alcohol. Not only are alcoholic drinks loaded with calories, they also tend to weaken your resolve to eat better.

The holidays can be a tough time to stick to healthy eating goals. But if your traditions involve baking, a few simple ingredient changes can help you cut some of the sugar, fat, and calories – without sacrificing the taste. This year, make some new baking traditions by adapting your family recipes with these tips:

Substitute whole-wheat flour for up to half of the white flour called for in the recipe.

Make muffins using oatmeal, bran, or whole-wheat flour.

Reduce the fat by ¼ (if a recipe calls for 1 cup of oil, use ¾ cup). You can also reduce the sugar by ¼.

If making sweet breads, such as banana bread or zucchini bread, cut the oil in half and replace with an equal amount of applesauce, mashed banana, or even canned pumpkin.

If a recipe calls for nuts, use half the amount and toast the nuts (whole, not chopped). This intensifies the flavor and saves on calories.

Tobacco use remains the single largest preventable cause of disease and premature death in the United States. Since the release of the Surgeon General’s Report on Smoking and Health 50 years ago, there have been 20 million deaths due to tobacco. Almost half the deaths from 12 different types of cancer combined – including lung, voice box, throat, esophagus, and bladder cancers – are attributable to cigarette smoking alone.

In addition to cancer, smoking greatly increases the risk of debilitating long-term lung diseases like emphysema and chronic bronchitis. It also raises the risk for heart attack, stroke, blood vessel diseases, and eye diseases. Half of all smokers who keep smoking will eventually die from a smoking-related illness.

That’s why it’s so important to quit. And no matter how old you are or how long you’ve smoked, quitting can help you live longer and be healthier. But quitting is hard, mostly because nicotine, a drug found naturally in tobacco, is so addictive. It’s as addictive as heroin or cocaine. Even so, millions of Americans have quit, and you can too. People have used many different methods to quit. Here is what the research tells us about how well they work:

Medications

Research shows that using a medication to help you quit smoking can double your chances of being successful.

The US Food and Drug Administration (FDA) has approved 7 medications to safely and effectively help people quit smoking. Choosing which one to use is often a matter of personal choice and should be discussed with your pharmacist or health care provider.

Three of these medications are available over-the-counter at most pharmacies and can be helpful in easing the symptoms of nicotine withdrawal when used as directed.

Nicotine gum

Nicotine patches

Nicotine lozenges

Four other medications are available by prescription.

Nicotine inhalers

Nicotine nasal sprays

Zyban (bupropion) – an antidepressant

Chantix (varenicline) – a drug that blocks the effects of nicotine in the brain

Counseling

Counseling combined with medication makes it even more likely than using medication alone that you can quit smoking and stay away from tobacco for good. Counseling comes in many forms.

In-person counseling is available from a doctor, nurse practitioner, pharmacist, or other health care providers.

Telephone quitlines: All 50 states and the District of Columbia offer some type of free, telephone-based program that links callers with trained counselors. People who use telephone counseling have twice the success rate in quitting smoking as those who don’t get this type of help. Call us at 1-800-227-2345 to get help finding a phone counseling program in your area.

Support groups have helped many smokers quit. Check with your employer, health insurance company, or local hospital to find a support group that fits your needs. Or call us at 1-800-227-2345.

Smokers who want to quit can also increase their chances of success by enlisting the help and support of family, friends, and co-workers. Tell your friends about your plans to quit. Try to spend time with non-smokers and ex-smokers who support your efforts. You can also suggest that those in your support system read Helping a Smoker Quit: Do’s and Don’ts.

Apps

Help to quit smoking is as close as your smartphone. But it’s important to choose a program that’s based on quit-smoking recommendations proven through research to be effective.

The Quit For Life® Program, provided by the American Cancer Society and Alere Health, offers a free smartphone app for iPhone and Android that offers daily tips and motivation, a cost-savings calculator, and a calendar to track your success.

The National Cancer Institute also has a quit-smoking app that allows users to set quit dates, track financial goals, schedule reminders, and more. It also offers a text messaging service that provides round-the-clock encouragement and advice to people trying to quit. You can sign up by texting “QUIT” to iQUIT (47848) and entering the date of your Quit Day – the day you will stop smoking.

Cold Turkey

Going cold turkey means that you stop smoking all at once. Even though ex-smokers often say they quit cold turkey, usually they had thought about stopping before they actually did it. It’s easier to quit this way if you smoke fewer than 10 cigarettes a day. Gradual withdrawal – smoking fewer cigarettes each day – can help reduce nicotine withdrawal symptoms and make it easier for some people to quit.

Electronic Cigarettes

Some users of e-cigarettes and other electronic nicotine delivery systems (ENDS) say these products have helped them quit smoking. But the evidence to date is only anecdotal, and it’s not always clear whether they mean they’ve quit all use of tobacco and nicotine, or they’ve simply switched from using conventional cigarettes to ENDS.

Marketers of e-cigarettes and other ENDS claim the ingredients are safe. But these products contain and emit addictive nicotine, flavorings, and a variety of chemicals, some known to be toxic or cause cancer - and research hasn’t yet established the level of potential risk posed by these unregulated and non-standardized products. And the FDA has not approved them as quitting aids.

According to Cliff Douglas, American Cancer Society vice president, tobacco control, the American Cancer Society cannot recommend that people use e-cigarettes, other ENDS, or any product that hasn’t gone through proper review and regulation for health and safety and been approved by the FDA.

Just this year, the FDA began regulating e-cigarettes. Among the new requirements, manufacturers of ENDS will have to subject these products to the FDA's rigorous testing of proposed quit-smoking devises and medications if they are going to be marketed for this purpose.

Researchers are actively studying the long-term health effects of these devices. In the meantime, there are reasons to be cautious.

Many e-cigarettes are not labeled with their ingredients, so the user doesn’t know what’s in them. The amounts of nicotine and other substances a person gets from the wide variety of these devices are known to vary a great deal.

Manufacturers claim that the ingredients are safe, but such claims are not proven. Some of the ingredients found in ENDS might be harmful, although, in general, products that are not burned are not as harmful as conventional, combustible tobacco products.

Bottom Line

One of the most important things researchers have learned about quitting smoking is that the smoker needs to keep trying. It may take several serious attempts before a smoker can quit forever. Rather than looking at a slip back to smoking as a failure, it should be considered an opportunity to learn from experience and be better prepared to quit the next time.

Caring for someone with cancer comes with a unique set of challenges. Caregivers may handle a loved one’s physical needs, medical needs, practical needs, and emotional needs – all while learning on the job. Having a reliable and respected source for help is critical in order for a caregiver to deliver the very best support they can. That’s why the American Cancer Society created The American Cancer Society Complete Guide to Family Caregiving, now in its second edition.

Who needs this book: This book was written for patients, families, and especially caregivers who need help coping with the wide range of physical, emotional, and social challenges that come with cancer and treatment.

Excerpts:

From Chapter One: Being an Effective Caregiver

Four important goals to keep in mind in your caregiving:

Work as a team with the person with cancer, health professionals, family, and friends.

Communicate with the person with cancer in order to involve him or her in all aspects of care as much as possible.

Be an advocate for the person with cancer to be sure that he or she gets the information and services that are needed.

Take care of your own needs so that you have the emotional and physical strength to be a helpful and effective caregiver.

. . . . . . .

From Chapter Eighteen: Tiredness and Fatigue

Cancer fatigue is real and should not be ignored. It can be caused by a number of different factors, and it’s not always possible to know exactly what the cause is. It may be caused by the disease itself or by the treatments. It may be caused by anemia, in which fewer red blood cells circulate and less oxygen is delivered to the body’s tissues. Fatigue may be caused by malnutrition (inadequate intake of nutrients) or a temporary increase in waste products as cancer cells are destroyed by cancer treatments.

Sometimes people feel tired after each course of cancer treatment. They complain of not having enough energy or not feeling like they can keep up with everyday activities. Fatigue may also happen because normal rest and sleep habits are disrupted or because the person with cancer is in pain or feels depressed.

Try not to push the person with cancer to do more than what she or he feels is reasonable. Let him or her decide how much to do. If other symptoms occur with increased fatigue, then it’s important to talk with the doctor or nurse.

When to Get Professional Help

Tiredness or fatigue by itself is not an emergency; however, some symptoms can be serious if they occur in combination with tiredness. When these symptoms occur with fatigue, get immediate help. Call the doctor or nurse if any of the following conditions exist along with fatigue:

Severe or frequent dizziness. Dizziness can happen when walking, getting out of bed, or moving from a sitting to a standing position. Dizziness can also occur without moving or changing one’s position. Dizziness can happen to anyone occasionally. If it is severe and frequent, get medical help. Severe dizziness can be caused by a drop in blood pressure, not eating or drinking enough, or other physical problems.

Falling followed by an injury, bleeding, mental confusion, or unconsciousness. Report all bad falls so the doctor or nurse can judge what caused the fall, whether bones were broken, and what follow-¬up is needed. Sometimes equipment may be recommended to prevent future falls. The doctor may refer the person to a physical therapist or occupational therapist for evaluation.

Inability to wake up. Call right away if you cannot wake the person or if his or her level of consciousness or alertness changes suddenly and unexpectedly. You will probably have to take the person to a medical facility for tests to determine the cause of this problem.

Feeling out of breath. Breathlessness usually happens because the body is not getting the right amount of oxygen. This symptom can be caused by a problem with the lungs and respiratory system or by a low level of red blood cells.

New data from the Centers for Disease Control and Prevention (CDC) show that 40% of cancers diagnosed in the US may have a link to tobacco use. The report was published in the November 11, 2016 issue of Vital Signs.

Tobacco use is the leading preventable cause of cancer and cancer deaths. It can cause cancer of the liver, colon and rectum, lung, oral cavity, esophagus, pharynx (throat), larynx (voice box), stomach, pancreas, bladder, kidney, and cervix, and acute myeloid leukemia.

According to the CDC, about 660,000 people in the US were diagnosed each year between 2009 and 2013 with a cancer related to tobacco use. About 343,000 people died.

Cigarette smoking drops, but not equally across populations

In a separate article in the November 11, 2016 issue of Morbidity and Mortality Weekly Report, the CDC released data from the National Health Interview Survey (NHIS). The data shows that current cigarette smoking among US adults declined from 20.9% in 2005 to 15.1% in 2015. That’s the lowest prevalence of adult cigarette smoking since the CDC began the NHIS survey in 1965.

Lisa C. Richardson, MD, MPH, director of CDC’s Division of Cancer Prevention and Control credits tobacco control programs for the decline. “When states invest in comprehensive cancer control programs—including tobacco control—we see greater benefits for everyone and fewer deaths from tobacco-related cancers. We have made progress, but our work is not done,” said Richardson in a statement.

Comprehensive tobacco control programs coordinate efforts to use proven strategies to keep young people from starting tobacco use, to help users quit, to eliminate exposure to secondhand smoke, and to find and stop tobacco-related disparities. Proven strategies include increasing prices of tobacco products, implementing and enforcing comprehensive smoke-free laws, and carrying out hard-hitting media campaigns.

However, not all populations have benefited equally from these efforts. According to the CDC, incidence and death rates for tobacco-related cancers were highest among African-Americans compared with other races or ethnicities. They were also higher among people with less education and in places with high poverty levels. Incidence rates were highest in the Northeast and lowest in the West. Incidence rates were also higher among men than women.

Tobacco comes in other forms

The CDC data focuses on cigarette smoking. However, the use of other tobacco products has increased in recent years. These include cigars, pipes, hookahs, and electronic cigarettes (e-cigarettes).

E-cigarettes contain and emit addictive nicotine, flavorings, and a variety of chemicals, some known to be toxic or cause cancer - and research hasn’t yet established the level of potential risk posed by these non-standardized products. The amounts of nicotine and other substances a person gets from the wide variety of these devices can vary sharply.

E-cigarettes can lead to nicotine addiction, especially in young people who may be experimenting with them. They may lead kids to try other tobacco products. This is of particular concern, because the use of e-cigarettes among middle and high school students is rising rapidly, even while use of traditional tobacco products is declining.

Current Cigarette Smoking Among Adults — United States, 2005–2015. Published November 11, 2016 in Morbidity and Mortality Weekly Report (MMWR). First author Ahmen Jamal, MBBS, Centers for Disease Control and Prevention, Atlanta.

When it comes to reducing your cancer risk, one important step could be right under your nose, or below your feet. Getting your home tested for radon can help protect you and your family from a key cause of lung cancer.

Exposure to radon accounts for about 21,000 deaths from lung cancer each year according to the US Environmental Protection Agency (EPA). While that is nowhere near the 480,000 deaths a year caused by smoking, it’s still significant. And it’s the leading cause of lung cancer in non-smokers.

What is radon?

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Radon is a gas that occurs naturally outdoors in harmless amounts. It’s produced from the breakdown of uranium in soil and rocks. It sometimes becomes concentrated in homes built on soil with natural uranium deposits. It can enter buildings through cracks in floors or walls, construction joints, or gaps in foundations around pipes, wires or pumps. Radon levels are usually highest in the basement or crawl space.

When radon gas is breathed in, it enters the lungs, exposing them to small amounts of radiation. This may damage the cells in the lining of the lungs and increase a person's risk of lung cancer. The risk of lung cancer is higher in those who have lived for many years in a radon-contaminated house.

The lung cancer risk from radon is much lower than that from smoking. However, exposure to the combination of radon gas and cigarette smoke creates a greater risk for lung cancer than either factor alone.

Testing for radon

Because radon gas can’t be seen or smelled, the only way to know whether it’s a problem in your home is to test for it. A Citizen’s Guide to Radon, produced by the EPA, explains how to test your home for radon easily and inexpensively, and what to do if your levels are too high.

You can hire a professional tester, or do it yourself with a kit you buy at a hardware store or online. Follow the instructions for leaving the kit in your house for the required number of days. Then mail it to a lab and wait for the results.

If you find out that your radon levels are high, you can take steps to lower the amount of radon in your home. The most common method is to have a vent pipe system and fan installed, which pulls radon from beneath the house and vents it to the outside.

It is also possible for radon to enter your home through your water supply, though this is a much lower risk than radon entering your home through the soil. If you have a private well, you can have it tested for radon. If the levels are high, you can have the water supply treated so that the radon is removed before it enters your home. If you are concerned about radon and your water comes from a public water supply, you should contact your supplier.

As with most home repairs, the cost of reducing radon in your home can vary widely, depending on how your home is built (whether you have a basement, crawlspace, or neither) and what kind of system you need.

If you think you’ve been exposed

There are no widely available medical tests to measure whether you have been exposed to radon. But if you think that you might have been, talk with your doctor about whether you should get regular health checkups and tests to look for possible signs of lung cancer. Possible symptoms include shortness of breath, a new or worsening cough, pain or tightness in the chest, hoarseness, or trouble swallowing.

If you smoke and you know you’ve been exposed to high levels of radon, it’s very important to quit smoking. The combination of cigarette smoking and radon exposure raises the risk of lung cancer more than either smoking or radon exposure alone.

For some people exposed to radon through their jobs, like uranium miners, millers and transporters, the US government has established the Radiation Exposure Compensation Program. It offers compensation for lung cancer and some other lung diseases to people who qualify.

As many as 20% of the people who die from lung cancer in the United States every year do not smoke or use any other form of tobacco. This translates to about 16,000 to 24,000 Americans every year. In fact, if lung cancer in non-smokers had its own separate category, it would rank among the top 10 fatal cancers in the United States.

It’s still true that staying away from tobacco is the most important thing any of us can do to lower our risk of getting lung cancer. But there are also other risk factors. Researchers have made a lot of progress over the past decade in understanding what causes lung cancer in non-smokers:

Radon gas. The leading cause of lung cancer in non-smokers is exposure to radon gas, according to the US Environmental Protection Agency (EPA). It accounts for about 21,000 deaths from lung cancer each year. Radon occurs naturally outdoors in harmless amounts, but sometimes becomes concentrated in homes built on soil with natural uranium deposits. Studies have found that the risk of lung cancer is higher in those who have lived for many years in a radon-contaminated house. Because radon gas can’t be seen or smelled, the only way to know whether it’s a problem in your home is to test for it. A Citizen’s Guide to Radon, produced by the EPA, explains how to test your home for radon easily and inexpensively, as well as what to do if your levels are too high.

Secondhand smoke. Each year, an estimated 7,330 adults die of lung cancer as a result of breathing secondhand smoke. Laws that ban smoking in public places have helped to reduce this danger. The American Cancer Society Cancer Action NetworkSM (ACS CAN), the nonprofit, nonpartisan advocacy affiliate of the American Cancer Society, is working to expand and strengthen these laws to further protect both smokers and non-smokers from the dangers of secondhand smoke.

Cancer-causing agents at work. For some people, the workplace is a source of exposure to carcinogens like asbestos and diesel exhaust. Work-related exposure to such cancer-causing materials has decreased in recent years, as the government and industry have taken steps to help protect workers. But the dangers are still present, and if you work around these agents, you should be careful to limit your exposure whenever possible.

Gene mutations. Researchers are learning more and more about what causes cells to become cancerous, and how lung cancer cells differ between non-smokers and smokers. For example, an article published in Clinical Cancer Research explains that a particular kind of gene mutation is much more common in lung cancer in non-smokers than smokers. This mutation activates a gene that normally helps cells grow and divide. The mutation causes the gene to be turned on constantly, so the lung cancer cells grow faster. Knowing which gene changes cause the cells to grow has helped researchers develop targeted therapies, drugs that specifically target these mutations.

Lifestyle changes to lower risk

Non-smokers have already eliminated their greatest risk factor for lung cancer. Male smokers are about 25 times more likely and female smokers are about 26 times more likely to get lung cancer than men and women who never smoked. But non-smokers can make some lifestyle changes to help reduce their risk even more.

Testing your home for radon, avoiding secondhand smoke, and limiting exposures at work can help you avoid the leading causes of lung cancer in non-smokers.

A healthy diet with lots of fruits and vegetables may also help reduce your risk of lung cancer. Some evidence suggests that a diet high in fruits and vegetables may help protect against lung cancer in both smokers and non-smokers. But any positive effect of fruits and vegetables on lung cancer risk would be much less than the increased risk from smoking.

A harsh truth about lung cancer is that it doesn’t usually cause symptoms until the cancer is already advanced and not able to be cured. That’s why the idea of screening – looking for lung cancer in people who do not have any symptoms – is appealing. It has the potential of finding the cancer earlier, when it’s easier to treat.

But screening carries risks that may outweigh the benefits for most people. The people who are most likely to benefit from screening are those at higher risk for lung cancer, such as people with a long history of smoking.

A computed tomography (CT or CAT) scan uses x-rays to produce detailed cross-sectional images of the lungs. It’s better than a regular x-ray at finding lung tumors and showing them clearly. That’s why CT scans are used for lung cancer screening.

One drawback of a CT scan is that it finds a lot of abnormalities that turn out not to be cancer but that still need to be checked out to be sure. This may lead to additional scans or even more-invasive tests such as needle biopsies or even surgery to remove a portion of lung in some people. A small number of people who do not have cancer or have very early stage cancer have died from these tests. There is also a risk that comes with increased exposure to radiation, even though a low dose is used for lung screening.

To weigh the benefits and risks before issuing current guidelines, experts at the American Cancer Society reviewed several studies that looked at low-dose CT screening. The most significant was the National Lung Screening Trial (NLST). This study included more than 50,000 people aged 55 to 74 who were current or former smokers with at least a 30 pack-year history of smoking (equal to smoking a pack a day for 30 years, or 2 packs a day for 15 years) and who had not quit more than 15 years ago. The NLST found that people who got low-dose CT had a 16% lower chance of dying from lung cancer than those who got chest x-rays. However, some other trials have not found a benefit from screening.

None of the studies included people who never smoked. Although non-smokers can develop lung cancer, there is not enough evidence to know whether screening them would be helpful or harmful. Likewise, it is not known if screening would help people who were lighter smokers than those in the studies, or those of different ages. That’s why the American Cancer Society guideline doesn’t recommend screening for these groups.

High-risk patients should consider getting screened

Because of the risks associated with low-dose CT scanning, and the possibility of doing more harm than good for people who are less likely to have lung cancer, the American Cancer Society recommends doctors discuss screening with people who are at high risk for developing the disease and help them make an informed decision about whether to get screened. If people do decide to get screened, they should get screened every year through age 74, as long as they are still healthy.

To be in the high risk category, patients must be aged 55 to 74 years and have a smoking history equivalent to a pack a day for 30 years, and currently smoke or have quit within the past 15 years. To be a good candidate for screening, patients need to be in fairly good health. For example, they need to be able to have surgery and other treatments to try to cure lung cancer if it is found.

Screening should only be done at facilities that have the right type of CT scan and that have a great deal of experience in low-dose CT scans for lung cancer screening. The facility should also have a team of specialists who can provide the appropriate care and follow-up of patients with abnormal results on the scans.

Medicare now covers screening

The Centers for Medicare and Medicaid Services (CMS) decided low-dose CT will be reimbursed once a year for Medicare patients who are eligible for lung cancer screening. Patients must be ages 55 to 77, have at least a 30 pack-year history of smoking, and currently smoke or have quit within the past 15 years.

Because lung screening is recommended by the US Preventive Services Task Force (USPSTF), private insurers have also begun covering the tests. However, the criteria for screening eligibility are slightly different. For example, USPSTF guidelines call for screening up to age 80.

Quitting is still best

Screening is not a substitute for quitting smoking. The most effective way to lower lung cancer risk is to stay away from tobacco.

Signs and symptoms of lung cancer

Although it is not common, lung cancer sometimes causes symptoms in the early stages. Most of the symptoms are more likely to be caused by something that isn’t lung cancer. But it’s important to go to the doctor so the cause can be found and treated. And if it does turn out to be lung cancer, it might be diagnosed at an earlier stage, when treatment is more likely to be effective.

The most common symptoms of lung cancer are:

A cough that does not go away or gets worse

Chest pain that is often worse with deep breathing, coughing, or laughing

Hoarseness

Weight loss and loss of appetite

Coughing up blood or rust-colored sputum (spit or phlegm)

Shortness of breath

Feeling tired or weak

Infections such as bronchitis and pneumonia that don’t go away or keep coming back

The American Cancer Society and the National Cancer Institute have launched an easy-to-use website to help cancer survivors during and after cancer treatment.

Springboard Beyond Cancer provides survivors with online tools to manage side effects from cancer treatment, cope with stress, improve healthy behaviors, communicate better with their health care teams, and ask for support from family and friends.

“With Springboard Beyond Cancer, we want to empower cancer survivors by giving them the information they need to help identify issues, set goals, and create a plan to more smoothly navigate the cancer journey and take control of their health,” said Corinne Leach, MPH, MS, PhD, a behavioral scientist and strategic director in the Behavioral Research Center at the American Cancer Society.

More than 15.5 million Americans with a history of cancer were alive as of January 2016 and that number is expected to grow to more than 20 million by 2026. The increasing number of survivors is due in part to advances in early detection and treatment of cancer. It’s also due partly to a growing and aging population.

Springboard Beyond Cancer lists dozens of common symptoms and side effects from cancer treatment – such as fatigue, hair loss, and anxiety – and offers advice and resources for dealing with them. Visitors to the site can download “cards” that summarize each topic. Additional topics include getting more exercise, quitting smoking, and other ways to develop a healthier lifestyle. They also include practical advice about talking to family and friends – including children – about your cancer, questions to ask your doctor and health care team, and understanding your rights in the workplace.

“We hope that Springboard Beyond Cancer, along with the close collaboration of their medical team, can help cancer survivors reduce their disease burden and improve their overall wellbeing,” said Erik Augustson, Ph.D., M.P.H., program director at the National Cancer Institute.

Exercise is not only safe and possible during and after breast cancer treatment, but it also can reduce symptoms and improve quality of life. Despite these benefits, a lot of women don't get any regular physical activity beyond their usual daily activities.

Studies of breast cancer survivors have shown that regular exercise significantly improves physical functioning and reduces fatigue. Certain kinds of exercise appear to help breast cancer survivors at high risk for arm, breast and chest swelling (lymphedema) avoid the condition. And some types of exercise can improve symptoms for those who already have it.

Physical activity has also been linked to a 24% decrease in breast cancer coming back, and a 34% decrease in breast cancer deaths. Always check with your doctor, however, before starting any exercise routine, to make sure it’s safe for you. While exercise is an important part of fitness, you need time to heal after surgery and should follow the advice of your health care team.

Help control weight – itself a risk factor for breast cancer recurrence

Questions to ask your doctor

Research has shown that patients are more likely to exercise if they have specific instruction to do so from their doctors. Patients and their caregivers should ask their doctors or medical team about the kind of exercise that’s right for them.

Ask if you have any risk factors or are taking any medications that could interfere with an exercise program.

Ask if it’s OK to drink extra fluids while exercising.

Ask if certain types of exercise are safer or better for you than others.

Ask if it’s safe for you to exercise above a moderate level of exertion (about as much effort as a brisk walk).

Ask if there are any warning signs you should look for while exercising, which would indicate you should stop.

Tips for exercising during cancer treatment

The goal of exercising during breast cancer treatment is to help maintain your endurance, strength, flexibility, and ability to do the things you need and want to do. Women who were used to exercising before they were diagnosed with breast cancer often have to reduce the amount and intensity of their program. Women who are new to exercise should start slowly and rest frequently.

Do some activity every day, even if it’s only for a few minutes.

Set up a daily routine that allows activity when you are feeling your best.

Try to include physical activity that uses large muscle groups (thighs, abdomen, chest, and back).

Try to include exercises that use resistance or light weights.

Try to include stretches, which increase your flexibility and maintain your range of motion.

Exercise moderately. This is not the time to push yourself too hard. Rest when you need to.

Unless you are told otherwise, eat a balanced diet that includes protein, and drink plenty of water.

Again, be sure to talk to your doctor before starting any new exercise routine.

Have you ever said “no thanks” to a tempting dessert or eaten only salad for lunch because you were trying to cut back? If so, you’re among many women who try every day to protect their health by eating right. The American Cancer Society recommends eating mostly vegetables, fruits, and whole grains, and less red meat (beef, pork, and lamb), less processed meat (bacon, sausage, luncheon meats, and hot dogs), and fewer sweets. A healthy diet can help reduce the risk of heart disease, diabetes, stroke, and certain cancer types.

A healthy diet can also help you get to and stay at a healthy weight. Overweight and obesity increase the risk for getting breast cancer. What’s less clear is the link between breast cancer risk and any one food type. Many studies about foods and breast cancer risk have had different results, but no clear-cut answers. Here is what the evidence tells us about fat, vitamin supplements, soy, dairy, and sugar.

Fat

Many studies have found that breast cancer is less common in countries where the typical diet is low in total fat, low in polyunsaturated fat, and low in saturated fat. But when researchers have looked at the amount of fat eaten by women in the United States, they have not found a link to breast cancer risk. This could be because women in countries where breast cancer is less common also have other differences besides the amount of fat they eat. Those differences may include how much physical activity they get, what else they eat, and genetic factors.

Vitamin Supplements

So far, no study has shown that taking vitamins reduces breast cancer risk. This includes vitamin D, which was studied to see if it could play a role in breast or colon cancer risk. The results didn’t prove anything one way or another. Health experts are reluctant to recommend vitamin supplements for lowering the risk of any type of cancer because some studies actually found an increased risk of breast cancer in women with higher levels of certain nutrients. If you take vitamins or are thinking about starting, you should talk to your doctor about it.

Soy

Studies about soy also show different things, but the differences are between studies in people and studies in animals.

In some animal studies, rats that were exposed to high doses of compounds found in soy called isoflavones showed an increased risk of breast cancer. This is thought to be because the isoflavones in soy can act like estrogen in the body, and increased estrogen has been linked to certain types of breast cancer. But rats process soy differently from people, and the same results have not been seen in people. In fact, in human studies, the estrogen effects of soy seem to either reduce breast cancer risk, or have no effect at all. This might be because the isoflavones can actually block the more potent natural estrogens in the blood.

So far, no reliable studies have pointed to any dangers from eating soy, and the health benefits appear to outweigh any potential risk. According to Marji McCullough, ScD, RD, strategic director of nutritional epidemiology for the American Cancer Society, soy foods are healthy and safe. But she advises against taking soy supplements – which contain much higher isoflavone concentrations than food – until more research is done.

Dairy

Some early studies raised concerns about whether drinking milk from cows treated with hormones could raise the risk of breast cancer or other types of cancer. But later studies failed to find a clear link. At this time, it is not clear that drinking milk produced with or without hormone treatment is of any concern regarding cancer risk or other health effects.

Sugar

A myth says: “Sugar feeds cancer.” But the truth is that sugar doesn't make cancer grow faster. All cells, including cancer cells, depend on blood sugar (glucose) for energy. But consuming more sugar does not make cancer cells grow faster, and starving them of sugar doesn’t make them grow slower.

However, eating a lot of sugar, including desserts and sugar-sweetened beverages, can lead to weight gain, which may increase the risk of breast cancer.

The Centers for Disease Control and Prevention (CDC) has revised its recommendation for the HPV vaccination for ages 9 through 14. Children in that age group can now get just 2 shots instead of 3. The shots can be given at least 6 months apart. The CDC continues to recommend that most children get the vaccine at age 11 or 12.

Debbie Saslow, PhD, senior director, HPV Related and Women’s Cancers at the American Cancer Society, said the new recommendation will make it easier for people to get protection from HPV. “It’s a burden on parents to get teenagers to the provider’s office. The new recommendations not only cut down on repeated trips, but also spread out the recommended interval. This adds the flexibility that allows the second shot to be given at a time when the child will already be at the provider’s office for something else – an annual checkup, a sports physical, or even something like a strep test.”

The new recommendations come from the Advisory Committee on Immunization Practices (ACIP), a group of medical and public health experts that develop recommendations on use of vaccines in the general population of the United States.

The first HPV vaccine dose is routinely recommended at 11-12 years old. The second dose of the vaccine should be given 6 to 12 months after the first dose.

Teens and young adults who start getting the vaccination at ages 15 through 26 years will continue to need 3 doses of HPV vaccine to protect against cancer-causing HPV infections.

Children and teens ages 9 through 14 who have already received 2 doses of HPV vaccine less than 6 months apart, will require a third dose.

Three doses are recommended for people with weakened immune systems aged 9-26 years.

Saslow said that the American Cancer Society will now start the process of reviewing and updating its own guidelines about HPV vaccine use.

Why get the HPV vaccine?

The HPV vaccine protects against human papilloma virus (HPV). Most cervical cancers are caused by HPV. The virus has also been linked to cancers of the vulva, vagina, penis, anus, and throat. HPV is also a major cause of genital warts.

Girls and boys should ideally begin getting the vaccine series at age 11 or 12. The vaccine causes a better immune response at this age than during the teenage years. Children are also likely still seeing their doctor regularly and getting other vaccinations at this age.

Soft tissue sarcomas are cancers that develop in muscles, fat, tendons, or other soft tissues anywhere in the body. There are not many treatment options available for this type of cancer; therefore, a new drug approval is a significant development.

Lartruvo is a monoclonal antibody, which is a manmade version of an immune system protein. It works by targeting a protein on cancer cells called PDGFR-alpha, which often helps these cells grow. Blocking this protein can help stop or slow tumor growth.

The FDA based its approval on a study of 133 people with more than 25 different subtypes of soft tissue sarcoma that had spread to other parts of the body. Some people in the study received Lartruvo and doxorubicin, and others received doxorubicin alone. The study looked at how long participants lived after treatment, how long tumors stopped growing after treatment, and how many participants saw their tumors shrink. All the results showed Lartruvo to be effective.

Participants who received both Lartruvo and doxorubicin lived for an average 26.5 months, compared to 14.7 months for those who received only doxorubicin.

Participants who received both Lartruvo and doxorubicin had a longer time when their tumors stopped growing after treatment compared with those who received only doxorubicin (8.2 months compared to 4.4 months).

More than 18% of participants who received both Lartruvo and doxorubicin saw their tumors shrink compared with 7.5% who received doxorubicin alone.

The FDA granted Lartruvo accelerated approval, priority review, breakthrough therapy status, and orphan product designation, all designed to speed up the approval process and to encourage development of new therapies for rare diseases.

The most common side effects of Lartruvo are nausea and vomiting, fatigue; low levels of white blood cells; muscle, bone, and abdominal pain; sores and swelling in the mucus membranes; hair loss; diarrhea; decreased appetite; nerve damage; and headache. Lartruvo can also cause an allergic-like reaction while getting the drug. Symptoms can include low blood pressure, fever, chills, and rash, but sometimes can be more serious. Lartruvo can harm an unborn baby if a woman takes it while she is pregnant.

Most of the time, women getting their routine mammogram will receive a letter within 30 days saying the results were normal. But if doctors find something suspicious, they’ll call you back – usually within just 5 days – to take new pictures or get other tests.

Getting that call can be scary, but a suspicious finding does not mean you have cancer.

What else could it be?

A suspicious finding may be just dense breast tissue, a cyst, or even a tumor that isn’t cancer. Other times, the image just isn’t clear and needs to be retaken. Or, if this is your first mammogram, your doctor may want to look at an area more closely simply because there is no previous mammogram to compare it with.

What will happen at the follow-up appointment?

You are likely to have another mammogram called a diagnostic mammogram. (Your previous mammogram was called a screening mammogram.) A diagnostic mammogram is still an x-ray of your breasts, but it’s done for a different reason. Often, more pictures are taken during a diagnostic mammogram so that any areas of concern can be carefully studied. A radiologist is on hand to advise the technician (the person who operates the mammogram machine) to be sure they have all the images that are needed.

You may also have an ultrasound test that uses sound waves to create a computer image of the tissues inside your breasts. For this test, you will lie on a table while a technician applies some gel and places a transducer – a small instrument that looks like a microphone – on your skin. The test is painless and does not expose you to radiation. This test is often used to look more closely at areas of concern found on a mammogram.

In addition, some women will have an MRI. For a breast MRI, you will lie face down inside a narrow tube for up to an hour while sensors capture information used to create a more detailed image of the tissues inside your breasts. The test is usually painless, but can be uncomfortable for people who don’t like small, enclosed spaces.

You can expect to learn the results of your tests during the visit. You are likely to be told 1 of 3 things:

The suspicious area turned out to be nothing to worry about and you can return to your regular mammogram schedule.

The area is probably nothing to worry about, but you should have your next mammogram sooner than normal – usually in 4 to 6 months – to make sure it doesn’t change over time.

Cancer was not ruled out and a biopsy is needed to tell for sure.

You will also get a letter with a summary of the findings that will tell you if you need follow-up tests or when you should schedule your next mammogram.

What if I need a biopsy?

Even if you need a breast biopsy, it still doesn’t mean you have cancer. Most biopsy results are not cancer, but a biopsy is the only way to find out. During the procedure, a small amount of tissue is removed and looked at under a microscope.

There are several different types of biopsies – most use a needle, but some use an incision. The type you have depends on things like how suspicious the tumor looks, how big it is, where it is in the breast, how many tumors there are, other medical problems you might have, and your personal preferences.

The tissue sample will be sent to a lab where a specialist, called a pathologist, will look at it. It will take a few days, maybe even more than a week, for you to find out the results. Once you get them, it’s important to learn whether the results are final, or whether you need another biopsy. You may also decide that you want to get a second opinion.

If the results are negative or benign, that means no cancer was found. Be sure to ask the doctor whether you need any additional follow-up, and when you should have your next screening mammogram. If the biopsy shows that you do have cancer, your doctor may refer you to a breast surgeon or other breast specialist.

What if it’s cancer?

If you do have cancer and you are referred to a breast specialist, use these tips to make your appointment as useful as possible:

Make a list of questions to ask at the appointment. Download a list from the American Cancer Society or call us at 1-800-227-2345.

Bring a family member or friend with you. They can serve as an extra pair of ears, help you remember things later, and give you support.

Ask if you can record important conversations.

Take notes. If someone uses a word you don’t know, ask them to spell it and explain it.

Ask the doctors or nurses to explain anything you don’t understand.

How can I stay calm while waiting?

Waiting for appointments and the results of tests can be frightening. Many women experience strong emotions including disbelief, anxiety, fear, anger, and sadness during this time. Some things to remember:

It’s normal to have these feelings.

Most breast changes are not cancer and are not life-threatening.

Talking with a loved one or a counselor about your feelings may help.

Talking with other women who have been through a breast biopsy may help.

The American Cancer Society is available at 1-800-227-2345 around the clock to answer your questions and provide support.

An important way to keep up with your breast health is to be aware of how your breasts normally look and feel, and know what changes to look for.

Finding breast cancer as early as possible gives you a better chance of successful treatment. But knowing what to look for is not a substitute for screening mammograms and other tests, which can help find breast cancer in its early stages, even before any symptoms appear.

Benign (non-cancerous) breast conditions are much more common than breast cancer, but it is important to let your health care team know about any changes in your breast so they can be checked out right away.

A lump in your breast

A lump or mass in the breast is the most common symptom of breast cancer. Such lumps are often hard and painless, though some may be painful. Not all lumps are cancer, though. There are a number of benign breast conditions (like cysts) that can also cause lumps. Still, it’s important to have your doctor check out any new lump or mass right away. If it does turn out to be cancer, the sooner it’s diagnosed the better.

Swelling in or around your breast, collarbone, or armpit

Swelling or lumps around your collarbone or armpits can be caused by breast cancer that has spread to lymph nodes in those areas. The swelling may occur even before you can feel a lump in your breast, so if you have this symptom, be sure to see a doctor.

Skin thickening or redness

If the skin of your breast starts to feel like an orange peel or gets red, have it checked right away. Often, these are caused by mastitis, a breast infection common among women who are breast feeding. Your doctor may prescribe antibiotics to treat the infection. If your symptoms don’t improve after a week, though, get checked again, because these symptoms can also be caused by inflammatory breast cancer. This form of breast cancer can look a lot like a breast infection, and because it grows quickly it’s important to diagnose it as soon as possible.

Breast warmth and itching

Like skin thickening and redness, breast warmth and itching may be symptoms of mastitis – or inflammatory breast cancer. If antibiotics don’t help, see your doctor again.

Nipple changes

Breast cancer can sometimes cause changes to how your nipple looks. If your nipple turns inward, or the skin on it thickens or gets red or scaly, get checked by a doctor right away. All of these can be symptoms of breast cancer.

Nipple discharge

A discharge (other than milk) from the nipple may be alarming, but in most cases it is caused by injury, infection, or a benign tumor (not cancer). Breast cancer is a possibility, though, especially if the fluid is bloody, so your doctor needs to check it out.

Pain

Although most breast cancers do not cause pain in the breast, some do. More often, women have breast pain or discomfort that is related to their menstrual cycle. This type of pain is most common in the week or so before their periods, and often goes away once menstruation begins. Some other benign breast conditions, such as mastitis, may cause a more sudden pain. In these cases the pain is not related to your menstrual cycle. If you have breast pain that is severe or persists and is not related to the menstrual cycle, you should be checked by your doctor. You could have cancer or a benign condition that needs to be treated.

Even though advancements in screening and treatment are making a difference in the fight against breast cancer, 246,660 women in the United States are expected to be diagnosed with the disease this year. For those who must face breast cancer, having a trusted, easy-to-read source for answers can be an invaluable way to feel more informed, more in control, and more prepared as they move forward with life and with treatment. The book Breast Cancer Clear & Simple, Second Edition, is designed to be just such a resource: a place to find thoughtful, straightforward answers that can make an overwhelming diagnosis easier to navigate.

Written by the experts at the American Cancer Society, the book uses a question-and-answer format to help guide a patient through the breast cancer journey. It provides a thorough overview of how breast cancer is diagnosed, staged, and treated, and includes helpful tools for patients, such as a checklist of questions to ask the medical team at each important step of their care. This second edition also provides information on topics including the latest in genetic counseling, the pros and cons of lumpectomy vs. mastectomy, targeted treatment of specific types of breast cancer, and how to tackle problems with finances, work, and relationships. The book is fully illustrated, and features a glossary of medical terms as well as a resource guide for patients who may want additional information or support.

This book in one sentence: Written in a straightforward question-and-answer format, Breast Cancer Clear & Simple, Second Edition will help a newly diagnosed breast cancer patient understand the disease and the latest treatment options available, so that they can make the best decisions for their care.

Who needs this book: Anyone with breast cancer who needs concise, authoritative information about the disease and how to manage it.

EXCERPTS:

What does “cancer stage” mean?

“Cancer stage” tells you how much cancer there is and if the cancer has spread.

The cancer stage helps your doctor determine your treatment options and figure out what is likely to happen with your cancer.

To decide the stage of your cancer, your doctor will use the results of the physical exam and biopsy, along with results from surgery, if applicable. Other tests that might be used include a chest x-ray, mammograms of both breasts, bone scans, computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, and positron emission tomography (PET) scans. (Most women won’t need all of these tests.)

In cancer staging, a system of letters and numbers is used to describe the following:

the size of your breast tumor;

whether your cancer has grown into nearby structures (like the skin);

whether your cancer has reached nearby lymph nodes; and

whether your cancer has spread to other parts of your body.

. . . . . . .

Questions to think about when deciding which type of surgery is best for you

What are the risks and benefits of having lumpectomy versus mastectomy?

How will I feel after losing one or both of my breasts?

Has my doctor recommended one approach over the other?

Am I at a higher risk for cancer recurrence (cancer coming back)?

Would one type of surgery lower the chances of cancer recurring more than the other?

How many lymph nodes, if any, will need to be removed?

Will I need radiation therapy or other treatments after surgery? What is involved with radiation therapy?

What side effects can I expect from the surgery? What can be done to help with these side effects? Which ones should be reported right away?

What if I decide to have breast reconstruction surgery after mastectomy? What will be involved?

For help with your order, call the Independent Publishers Group (IPG) at 800-888-4741.

]]>http://www.cancer.org/Cancer/news/Features/five-ways-to-fight-breast-cancerMon, 10 Oct 2016 13:10:00 -0400Breast CancerAdvocacyACS Programs and ServicesWant to join the fight against breast cancer? Here are 5 ways to do a lot of good with a little – or a lot – of your time, your skills, and your voice.

1. Volunteer your time

The American Cancer Society offers many programs that focus on the physical, social, and emotional needs of people facing breast cancer.

Reach To Recovery® – If you have survived breast cancer, you can train to become a Reach To Recovery® volunteer who provides education and emotional support to other women – and men – facing a breast cancer diagnosis.

Look Good Feel Better® – This free, community-based service teaches patients beauty techniques to help restore their appearance and self-image during cancer treatment. Programs are available in English and Spanish. Look Good Feel Better is a collaboration among the American Cancer Society, the Personal Care Products Council, and the Professional Beauty Association/National Cosmetology Association.

Road To Recovery® – Volunteer drivers in this program help cancer patients get to and from treatments. Last year, the American Cancer Society matched thousands of patients with volunteer drivers who donated their time and use of their cars.

2. Take part in research

As a breast cancer patient, you can seek out a clinical trial or sign up to be part of a research project that could help those diagnosed with breast cancer in the future. People who have never had cancer can help, too. For example, the American Cancer Society has conducted multiple studies over the past several decades that examine cancer causes, prevention, and survivorship issues in large groups of people. The latest of these is Cancer Prevention Study-3. By sharing information about their lifestyle and health status, participants in these studies give scientists the data they need to battle cancer at the world-wide level.

3. Make your voice heard

Many battles in the fight against breast cancer happen in your local legislature as well as in Washington, DC. The American Cancer Society’s advocacy organization, the American Cancer Society Cancer Action Network (ACS CAN), can help you become informed about cancer issues and exercise your rights as a citizen to support the causes you feel passionate about. For example, you can sign a petition to support the federal program that helps ensure all women have access to lifesaving mammograms.

4. Participate in Making Strides Against Breast Cancer

The American Cancer Society’s Making Strides Against Breast Cancer event raises millions of dollars every year to fund breast cancer research and provide information, services, and access to mammograms for women who need them. You can help by walking in a Making Strides event and raising donations, sponsoring another Making Strides walker, or volunteering your time and talent at an event. Nationwide, nearly 300 walks occur each year to honor breast cancer survivors, raise awareness, and raise money.

5. Take charge of your health

Although there's no sure-fire way to prevent breast cancer, certain lifestyle habits are linked to a lower risk of it developing or returning.

Be physically active. Evidence is growing that regular physical activity helps reduce your breast cancer risk. It also helps keep your weight under control, which may also lower your risk.

Eat a healthy diet. Studies link a diet rich in vegetables, fruits, poultry, fish, and low-fat dairy products to a reduced breast cancer risk. A healthy diet also helps you stay at a healthy weight.

If you drink alcohol, limit how much you drink. Research has shown that women who have 2 or more alcoholic drinks daily have a higher risk of breast cancer than women who drink only 1 drink a day or not at all.

ACS News Center stories are provided as a source of cancer-related news and are not intended to be used as press releases. For reprint requests, please contact permissionrequest@cancer.org.

]]>http://www.cancer.org/Cancer/news/Features/nfl-helps-american-cancer-society-fight-breast-cancerTue, 04 Oct 2016 14:04:00 -0400Breast CancerProfessional football and the color pink go together during October, National Breast Cancer Awareness Month. Each October, the National Football League joins the American Cancer Society to raise awareness about the importance of regular breast exams and to raise money to help fight breast cancer.

Since 2009, the American Cancer Society has partnered with the NFL, its franchise clubs, players, and the NFL Players Association on “A Crucial Catch,” a breast cancer awareness initiative that conveys an important public health message promoting early detection and the importance of breast cancer screening, and addresses the unequal burden of cancer in underserved communities, while raising funds for the American Cancer Society. A Crucial Catch Day will be held across the country on Tuesday, October 25 this year.

Throughout October, NFL players, coaches and referees will wear pink on the field to remind everyone about the importance for women to get mammograms to find breast cancer early, when it’s easier to treat. Hats, wristbands and other apparel worn at NFL games, and special footballs and pink coins will be auctioned off and proceeds will benefit the American Cancer Society. Fans attending games are encouraged to wear pink. Specially licensed pink merchandise is also sold at NFLShop.com, and at select retail stores nationwide.

To date the NFL’s work has raised nearly $15 million for American Cancer Society programs including the Community Health Advocates implementing Nationwide Grants for Empowerment and Equity (CHANGE) program. The CHANGE Grant program provides education and access to breast cancer screening resources to women who are uninsured or under-insured and don’t have access to screening. In just 4 years, CHANGE grants funded by the NFL have provided more than 120,000 breast cancer screenings at low or no cost. Other programs provide breast cancer patients and other cancer patients who call for help with free services including a place to stay while traveling for treatment, rides to treatment, and referrals to local support groups.

Help women stay healthy

Through A Crucial Catch, the NFL and American Cancer Society remind women to stay healthy and help lower risk for breast cancer by eating right and getting regular exercise.

Join the team

A Crucial Catch invites youth and high school teams to take part by hosting their own breast cancer awareness games, in which players and coaches wear school-provided special pink uniforms, wristbands, shoelaces, etc., and help raise funds in support of the American Cancer Society’s fight against breast cancer.

Through A Crucial Catch, football clubs and fans can register teams to participate in the American Cancer Society Making Strides Against Breast Cancer walk. This noncompetitive event raises millions of dollars every year to fund breast cancer research and provide information, services, and access to mammograms for women who need them.

For the past 30 years, Americans have been sweetening their diets with more and more sugar. These days, we each consume an average 20 teaspoons of sugar a day – most of it from soda and other soft drinks, candy, desserts, and sweetened dairy products – according to the American Heart Association (AHA).

The AHA recommends no more than 5 teaspoons of sugar a day for women and 9 for men on average. Children under age 2 should have no food or drinks sweetened with sugar. Children and teens up to 18 should be limited to 6 teaspoons of added sugars per day and limited to no more than 8 ounces per week of drinks sweetened with sugar. That means just one 12-ounce soda, which contains about 10 teaspoons of sugar, is too much.

All this sugar adds extra calories to our bodies without contributing any nutrients. Calories can lead to extra weight and even obesity, which increases the risks for serious health problems including cancer, heart disease, and diabetes.

What about natural sugars?

Fruits and vegetables and other foods that are part of a nutritious diet naturally contain sugar. This type of sugar is different from the sugars that are added to food to make it taste better.

So-called “natural” sweeteners – including fruit juice, nectars, honey, molasses, and maple syrup – are sometimes marketed as healthier than refined white sugar or corn syrup. But the truth is there is no health advantage to consuming added sugar of any type. Whether it’s “natural” or refined, too much sugar can lead to weight gain, poor nutrition, and tooth decay. (In addition, honey should never be given to children younger than age 1.)

How to cut back

Try these tips from the AHA:

Add less sugar to coffee or tea.

Drink sugar-free or low-calorie beverages.

Eat fresh fruits or fruits canned in water or natural juice instead of fruit canned in syrup.

Add fresh or dried fruit instead of sugar to pancakes, cereal, or oatmeal.

Cut the sugar called for in recipes by one-third to one-half. Often you won’t notice the difference.

Handling Halloween

Halloween is practically synonymous with candy. How to limit the sugar without spoiling the fun? Here are some tried-and-true tips:

Give kids a smaller bag to carry, or limit the number of houses they are allowed to visit.

Keep the candy out of sight, and allow a few pieces a day.

Buy back the candy from your kids, and let them use the money to buy a toy or game.

Have healthier Halloween-themed foods on hand so the kids aren’t as tempted by candy. Bob for apples, roast pumpkin seeds, pour popcorn into clear plastic gloves to make “skeleton” hands, or scoop out oranges and mix with other cut-up fruit to make jack-o’-lantern fruit cups.

Start a trend by giving out small toys and stickers instead of candy to the children who come to your door.

ACS News Center stories are provided as a source of cancer-related news and are not intended to be used as press releases. For reprint requests, please contact permissionrequest@cancer.org.

]]>http://www.cancer.org/Cancer/news/Features/new-acs-cookbook-offers-tasty-good-for-you-recipesMon, 03 Oct 2016 12:51:00 -0400Diet/Exercise/WeightWith 120 all-new recipes including Mini Twice-Baked Potatoes, Chicken Paillard with Arugula and Fennel, and Corn, Avocado, and Tomato Salad, The New Healthy Eating Cookbook, Fourth Edition can help home cooks and their families eat better without sacrificing flavor or taste.

The recipes were reviewed by the American Cancer Society’s medical and nutrition experts and emphasize fresh fruits and vegetables, whole grains, and lean protein. The New Healthy Eating Cookbook also includes tips on portion control, meal planning, healthy snacking, and reading nutrition labels.

“Good health starts with good nutrition, and this cookbook is a perfect resource,” said Colleen Doyle, managing director of nutrition and physical activity. “It’s filled with delicious recipes to please any palate and will remind readers that food can be healthy and also taste great and look beautiful.”

Author Jeanne Besser says the cookbook is appropriate for cooks of all levels of expertise who want to try new recipes and make healthy choices about the food they eat and serve. “Healthy eating doesn’t mean sacrificing flavor,” says Besser. “Anyone can use this book to create delicious meals that also happen to be good for you.”

For example, Corn, Avocado, and Tomato Salad can be served as a side dish or paired with tortilla chips for an appetizer. If you are using fresh corn, boil or steam 3 ears for 1 minute before cutting the kernels off the cob. If you don’t have fresh, use frozen (defrosted) or canned corn.

Recipe: Corn, Avocado, and Tomato Salad

Ingredients:

2 cups corn

1 cup grape tomatoes, halved

1⁄2 small red onion, chopped

1 jalapeño pepper, seeded and finely chopped

2 tablespoons fresh lime juice

1 tablespoon olive oil

1 teaspoon ground cumin

Salt and freshly ground black pepper

1 avocado, cut into 1⁄2-inch pieces

1⁄4 cup chopped fresh cilantro

In a bowl, combine the corn, tomatoes, onion, and jalapeño.

In a bowl, combine the lime juice, oil, and cumin (or put into a jar and shake well). Drizzle the dressing over the salad to lightly coat and stir gently to combine. Season with salt and pepper. Add avocado and cilantro and stir gently to combine.

While you can’t change some breast cancer risk factors—family history and aging, for example—there are some risk factors that you can control. And while there is no sure way to prevent breast cancer, there are things you can do that may lower your risk. Here are 5 ways to help protect your breast health.

1. Watch your weight.Being overweight or obese increases breast cancer risk. This is especially true after menopause and for women who gain weight as adults. After menopause, most of your estrogen comes from fat tissue. Having more fat tissue can increase your chance of getting breast cancer by raising estrogen levels. Also, women who are overweight tend to have higher levels of insulin, another hormone. Higher insulin levels have also been linked to some cancers, including breast cancer.

If you’re already at a healthy weight, stay there. If you’re carrying extra pounds, try to lose some. There’s some evidence that losing weight may lower breast cancer risk. Losing even a small amount of weight – for example, half a pound a week – can also have other health benefits and is a good place to start.

2. Exercise regularly. Many studies have found that exercise is a breast-healthy habit. The difference in risk between the most active and the least active women is typically around 25%. In one study from the Women's Health Initiative, as little as 1.25 to 2.5 hours per week of brisk walking reduced a woman's risk by 18%. Walking 10 hours a week reduced the risk a little more.

The American Cancer Society recommends getting at least 150 minutes of moderate-intensity activity or 75 minutes of vigorous activity each week. (Or a combination of both.) And don’t cram it all into a single workout – spread it out over the week.

3. Limit time spent sitting. Evidence is growing that sitting time, no matter how much exercise you get when you aren’t sitting, increases the likelihood of developing cancer, especially for women. In an American Cancer Society study, women who spent 6 hours or more a day sitting outside of work had a 10% greater risk for invasive breast cancer compared with women who sat less than 3 hours a day, and an increased risk for other cancer types as well.

It’s not clear how or why alcohol increases the risk, or which women are most likely to be affected. But limiting alcohol is especially important for women who have other risk factors for breast cancer, such as breast cancer in their families.

5. Avoid or limit hormone replacement therapy.Hormone replacement therapy (HRT) was used more often in the past to help control night sweats, hot flashes, and other troublesome symptoms of menopause. But researchers now know that postmenopausal women who take a combination of estrogen and progestin may be more likely to develop breast cancer. Breast cancer risk appears to return to normal within 5 years after stopping the combination of hormones.

Talk with your doctor about all the options to control your menopause symptoms, and the risks and benefits of each. If you do decide to try HRT, it is best to use it at the lowest dose that works for you and for as short a time as possible.

A mammogram is an important step in taking care of yourself and your breasts. A mammogram is a low-dose x-ray that allows specialists to look for changes in breast tissue that aren’t normal. The American Cancer Society recommends that starting at age 40 women at average risk should have the choice to begin yearly mammograms. Women should begin yearly mammograms at age 45, and they can switch to every 2 years at age 55. And all women, no matter their age, need to let their doctor know about any changes to their breasts.

Whether you’re a mammogram newbie or a veteran, knowing what to expect may help you navigate the process more smoothly. Talk to your doctor about the breast screening plan that is best for you.

Where to go: Find a center that specializes in mammograms. The US Food and Drug Administration certifies mammogram facilities that meet high professional standards of quality and safety. Ask to see the FDA certificate if one isn’t posted near the receptionist’s desk when you arrive. And when you find a facility you like, stick with it. Having all your mammograms at the same facility will make it easier for doctors to compare images from one year to the next.

When to schedule: It’s best to schedule your mammogram for the week after your menstrual period. Your breasts won’t be tender or swollen, which means less discomfort during the x-ray and a clearer picture.

What (and what not) to wear: Wear a 2-piece outfit because you will need to remove your top and bra. Do not apply deodorant, antiperspirant, powder, lotion, or ointment on or around your chest on the day of your mammogram. These products can appear as white spots on the x-ray.

What to expect: The entire procedure takes about 20 minutes. The breast is compressed for a few seconds while an x-ray picture is taken. The breast is repositioned (and compressed again) to take another view. This is then done on the other breast. Flattening the breast tissue, while uncomfortable for some women, provides a clearer view of the breast and lessens the amount of radiation needed to take an x-ray picture.

Getting the results: You should get your results within 30 days. If you don’t, you should call to ask about them. If doctors find something suspicious, you’ll likely be contacted within a week to take new pictures or get other tests. But that doesn’t mean you have cancer. A suspicious finding may be just dense breast tissue or a cyst. Other times, the image just isn’t clear and needs to be retaken. If this is your first mammogram, your doctor may want to look at an area more closely simply because there is no previous mammogram for comparison.

What you pay: Under the Affordable Care Act, Medicare and almost all private insurance plans now cover annual mammograms, with no co-pay or other out-of-pocket costs. Medicaid also covers mammograms. For uninsured or low-income women, free or low-cost programs are available. Some programs are held during Breast Cancer Awareness Month in October, while others are offered year-round. Call the American Cancer Society at 1-800-227-2345 to find a program near you.

Engaging in regular exercise is good for you for many reasons, and one of them is to lower your risk of getting breast cancer. Many studies conducted over the past 20 years have shown that an increase in physical activity is linked to a lower breast cancer risk. The difference in risk between the most active and the least active women is typically around 25%.

How exercising lowers breast cancer risk is not fully understood. It’s thought that physical activity regulates hormones including estrogen and insulin, which can fuel breast cancer growth. Regular exercise also helps women stay at a healthy weight, which also helps regulate hormones and helps keep the immune system healthier.

How much exercise do women need?

Unfortunately, there is not a magic number of hours that a women can exercise to prevent cancer from occurring or to lower risk. But we do know that some is better than none, and more is better than less. Also, more vigorous activity is more effective than less vigorous activity.

In one study from the Women's Health Initiative, as little as 1.25 to 2.5 hours per week of brisk walking reduced a woman's risk by 18%. Walking 10 hours a week reduced the risk a little more. The American Cancer Society recommends all adults engage in at least 150 minutes (2.5 hours) of moderate intensity or 75 minutes (1.25) hours of vigorous intensity activity each week, preferably spread throughout the week.

Examples of moderate intensity activities include brisk walking, dancing, leisurely bicycling, yoga, golfing, softball, doubles tennis, and general yard and garden maintenance. Examples of vigorous intensity activities include jogging, running, fast bicycling, swimming, aerobic dance, soccer, singles tennis, and basketball. All of these activities are in addition to those that are part of your usual routine at home and work – things like walking from your car to the garage, and climbing a flight of stairs.

Limit the time you spend sitting

Another advantage to exercising is that when you’re exercising, you aren’t just sitting. Evidence is growing that the time you spend sitting, no matter how much exercise you get when you aren’t sitting, increases the likelihood of developing breast cancer and some other types of cancer, as well as obesity, type 2 diabetes, and heart disease.

For many of us, working means sitting at a desk for long stretches. That makes it even more important to incorporate activity into your day. Here are some ideas:

Limit time spent watching TV and using other forms of screen-based entertainment.

Use a stationary bicycle or treadmill when you do watch TV.

Use stairs rather than an elevator.

If you can, walk or bike to your destination.

Exercise at lunch with your coworkers, family, or friends.

Take an exercise break at work to stretch or take a quick walk.

Walk to visit coworkers instead of sending an e-mail.

Go dancing with your spouse or friends.

Plan active vacations rather than driving only trips.

Wear a pedometer every day and increase your number of daily steps.

Join a sports team.

For people who haven’t exercised in a while, it makes sense to start slowly and build up gradually. And clear any new activity with your doctor.

Managing weight is a challenge for most people in the US. In fact, according to the Centers for Disease Control and Prevention (CDC), more than 70% of American adults are overweight.

This puts them at higher risk for serious conditions including diabetes, heart disease, and some types of cancer. For women, being overweight or obese after menopause increases the risk of breast cancer.

The female hormone estrogen can help breast cancer grow. After menopause, most of your estrogen comes from fat tissue. Having more fat tissue can increase your chance of getting breast cancer by raising estrogen levels. Also, women who are overweight tend to have higher levels of insulin, another hormone. Higher insulin levels have also been linked to some cancers, including breast cancer.

But the connection between weight and breast cancer risk is complicated. Studies suggest the risk appears to be increased for women who gained weight as an adult but may not be increased among those who have been overweight since childhood. For example, the American Cancer Society Cancer Prevention Study-II found that women who gained 60 or more pounds after age 18 had double the risk of being diagnosed with post-menopausal breast cancer compared to women who maintained their weight over the same time period.

And even though it’s been established that gaining weight raises your risk, it’s not clear whether losing weight reduces your risk. This turns out to be a tough question for scientists to answer, mainly because very few people actually lose weight during adulthood, and those who do lose weight don't usually keep it off over a long period of time. So it is difficult to find a large enough group of people to study.

But there is some evidence to show that losing weight helps. Research from the Nurses' Health Study found women who lost weight and kept it off for 4 or more years after menopause had a 40% lower risk of breast cancer. Another study found that weight-loss surgery was associated with an 83% lower risk of breast cancer. However, it is not clear the results from surgery patients can be applied to people who lose weight more gradually, from exercise and eating healthier.

We do know that avoiding weight gain is helpful, whether you are overweight now or not. If you’re carrying extra pounds, losing as little as 5%-10% of your weight improves your overall health. A good goal for most overweight women is to drop half a pound per week for 6 months. What's more, exercise can also lower breast cancer risk above and beyond the impact it can have on losing weight. Many studies have found that exercise is a breast-healthy habit. As little as 75 to 150 minutes of brisk walking each week has been shown to lower risk. Ramping up your exercise routine even more may lower your breast cancer risk even further.

Frank, open discussions between cancer patients and their doctors is a key part of getting good care. Ideally, these discussions help patients make informed decisions by giving them a good understanding of what to expect from treatment and their chances for recovery (prognosis).

But often, especially for patients who may be near the end of life, high quality conversations about quality of life, prognosis, and treatment choices happen either too late or not at all. And when they do happen, misunderstandings often occur that can lead patients to have unrealistic expectations and make treatment choices that they or their loved ones might later regret.

Researchers from the University of Rochester set out to learn whether training patients/caregivers and oncologists would help improve their communication. The study involved 265 people with advanced cancer and 38 oncologists. Half the people in each group were randomly assigned to receive training.

The training was brief, so it was more likely participants would complete it. Training for patients included meetings with social workers or nurses to practice asking questions, expressing their fears, being assertive, and stating their preferences. They were also given a booklet to read. Doctors’ coaching included mock office sessions with actors portraying patients, video training, and customized feedback.

Mixed results

In conversations among trained doctors and patients, the patients were much more likely to be motivated to ask questions. Their oncologists were also more emotionally engaged. In addition, more meaningful discussions occurred about difficult topics including prognosis and end-of-life issues.

However, gaps in understanding between patients and oncologists remained. For example, some patients believed it was likely they would be cured, and more than half thought they would still be alive in 2 years, but average survival in this study was 16 months. “We need to embed communication interventions into the fabric of everyday clinical care,” said co-author Ronald Epstein, MD. “This does not take a lot of time, but in our audio-recordings there was precious little dialogue that reaffirmed the human experience and the needs of patients. The next step is to make good communication the rule, not the exception, so that cancer patients’ voices can be heard.”

Tips for meaningful discussions

The goals of training were to get patients more involved in discussions with doctors about their care and to encourage doctors to be more responsive to patients’ emotions and discussions about prognosis. As a result, the researchers found that patients were more likely to ask about their treatment choices and their chances of getting better.

Patients who received training were encouraged to:

Be assertive

Ask questions about their disease, treatment choices, prognosis, and quality of life

Ask about the pros and cons of important choices

Ask for clarification when they didn’t understand something

Express concerns and opinions

Express emotions including fear and sadness

Doctors who received training were encouraged to:

Ask patients what questions were most important to them

Ask patients what they wanted to know about their prognosis and treatment choices

Check that patients understood what they were saying

Give pauses in the conversation for patients to answer or process the information just discussed

Explain the percentage of patients who are likely to benefit from a treatment, and the percentage of patients who are not likely to benefit

More than 1 in 4 Americans ages 50 and older get no physical activity beyond their normal daily routine, according to a new report from the US Centers for Disease Control and Prevention (CDC). That’s about 31 million people.

According to the CDC, regular physical activity is vital for healthy aging. It can reduce the risk of early death and help prevent, delay, or manage many chronic diseases faced by adults ages 50 and older. These include stroke, heart disease, arthritis, some types of cancer, diabetes, lung disease (COPD), and depression. In 2014, the CDC says 2 in 3 adults ages 50 and older had at least one chronic disease.

The American Cancer Society recommends that adults get at least 150 minutes of moderate-intensity activity (like brisk walking) or 75 minutes of vigorous-intensity activity each week, preferably spread throughout the week. Vigorous activities are performed at a higher intensity and cause an increased heart rate, sweating, and a faster breathing rate.

However, getting any amount of physical activity still offers some health benefits. Even a little bit is better than none. For people who are inactive, starting slowly and gradually adding more activity can be an important step toward better health. The CDC recommends setting a goal to do 10 more minutes of activity this week than you did last week.

Activity levels vary among populations

The report, "Physical Inactivity Among Adults 50 Years and Older – United States, 2014," was published September 16, 2016 in Morbidity and Mortality Weekly Report.

In it, the CDC looked at surveys from almost 277,000 people ages 50 and older living in all 50 states and Washington, DC. The surveys asked people about their level of activity and whether they’ve been diagnosed with a chronic disease. Overall, 27.5% of people in the study said they were inactive, meaning they did no physical activity outside of work.

In addition, people were more likely to be inactive as they got older:

32.7% of Hispanics were inactive compared with 33.1% of non-Hispanic blacks, 26.2% of non-Hispanic whites, and 27.1% of those of other ethnicities.

The less education people had, the more likely they were to be inactive.

The more overweight people were, the more likely they were to be inactive.

Inactivity was highest in the South (30.1%) and lowest in the West (23.1%).

Those who had ever been diagnosed with a chronic disease were 30% more likely to be inactive than those who had not.

Community action needed

The CDC is urging communities to break down barriers that may prevent some older Americans from being physically active by providing safe places for them to do so. At the local government level, officials can design communities that make it safe and easy for people of all ages and abilities to be active and make public spaces available to them. Transportation engineers and planning professionals can make communities more walkable and support public transit systems. Community organizations can offer and promote programs that encourage physical activity.

What you can do

Be physically active with friends, family, and work colleagues on a regular basis.

Make walking to the store, the office, or the bus part of your daily routine.

Try a recreational program designed for your age group or mobility level.

Participate in local planning efforts that support safe and convenient places to be active.

Continue to be physically active even if you have a chronic disease or disability, by engaging in activities appropriate for your ability.

Talk to your doctor about the type and level of activity that is safe for you.

Citation: Physical Inactivity Among Adults 50 Years and Older – United States, 2014. Published September 16, 2016 in Morbidity and Mortality Weekly Report. First author Kathleen B. Watson, PhD, Centers for Disease Control and Prevention, Atlanta, Ga.

A study of men in the United Kingdom with early-stage prostate cancer found they were just as likely to survive 10 years whether they had surgery, radiation, or active monitoring – which meant closely watching their disease for any changes and giving them active treatment only if needed. The findings may help men whose prostate cancer is detected through PSA testing make the difficult choice of how to be treated.

Death from prostate cancer was very low overall in the study, with only 1% of men dying from prostate cancer after 10 years, no matter which treatment group they were in. Men in each treatment group were also about equally likely to die of any cause during the study. But there were differences among the groups:

Fewer men (about 2% to 3%) in the surgery and radiation groups had metastasis – meaning their cancer spread to other parts of their body – compared with about 6% of men in the active monitoring group.

Men who had surgery or radiation were more likely to have side effects that included bowel, bladder, and sexual problems. Of the men in the active monitoring group, about half did not end up needing treatment during the study, so they were able to avoid these potential side effects.

Otis W. Brawley, MD, chief medical officer of the American Cancer Society, says the study shows that active monitoring is a reasonable option for men diagnosed with localized prostate cancer through PSA screening, especially if they have low- or moderate grade-disease.

“As the authors point out, active surveillance and/or delayed treatment avoids the side effects from treatment in those who do not need treatment, but there is an increased risk of cancer progression and spread, and some symptoms may increase gradually over time.

“The American Cancer Society recommends men be informed of the potential risks and potential benefits of prostate cancer screening and treatment before making a decision about whether to be screened. This study will help inform that discussion for men making what is a highly personal, and often difficult choice,” said Brawley.

The study involved about 1,600 men in the United Kingdom aged 50 to 69 who were diagnosed with prostate cancer after having an elevated PSA test result. The men were assigned randomly to get surgery to remove their prostate, external-beam radiation, or active monitoring.

While the results showed no difference in death from prostate cancer among the groups after 10 years of monitoring, it remains to be seen whether differences will show up after a longer follow-up period. This could be especially important for younger men diagnosed with prostate cancer, who could potentially live several more decades after their diagnosis.

The study was published online September 14, 2016 in the New England Journal of Medicine.

Citations:

10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer. Published online September 14, 2016 in the New England Journal of Medicine. First author Freddie C. Hamdy, FRCS (Urol.), F.Med.Sci, University of Oxford, United Kingdom.

Patient-Reported Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer. Published online September 14, 2016 in the New England Journal of Medicine. First author Jenny L. Donovan, PhD, F.Med.Sci, University of Bristol, United Kingdom.

Estimates show that in 2016, more than 10,000 children in the United States under the age of 15 will be diagnosed with cancer. That means thousands of patients and families will face the physical and emotional challenges that come when cancer impacts a young child.

To help support and encourage people touched by childhood cancer, especially during Childhood Cancer Awareness Month in September, the American Cancer Society offers an excerpt of My Cancer Days, a book that helps kids explore the emotional ups and downs of daily life during treatment. Appropriate for younger and older children alike, this work offers thoughtful and encouraging words to help kids express their feelings as they face the disease.

My Cancer Days has been awarded a Silver Medal in the National Health Information Awards. This prestigious awards competition sets an industry standard of quality for consumer health materials and helps health professionals find the best consumer health information resources for their programs. Entries were submitted by a wide variety of leading organizations in the consumer health field.

This book in one sentence: In the beautifully illustrated book My Cancer Days, a child uses colors to describe her emotions during cancer treatment and, ultimately, comes to realize that her feelings are normal and it’s okay to let them out.

Who needs this book: Any child who is going through treatment for cancer or another chronic illness.

What you'll get out of this book: This book’s vibrant images and its warm and encouraging message will reassure children with cancer that it is healthy to express their emotions during treatment. This book will give hope and encouragement to children with cancer in words they can relate to.

Most Americans drink at least 1 cup of coffee a day, and many feel like they can’t face the morning without it. So wouldn’t it be great if our beloved beverage helped protect us from cancer? There is, in fact, some reason to believe it could. Coffee is brewed from beans that contain antioxidants, which are thought to have a protective effect against cancer.

Researchers have conducted more than 1,000 studies looking at this question, with mixed results. Some early studies seemed to show that coffee might increase risk of some cancer types. Since then, however, larger and better designed studies have weakened those conclusions. And many of the newer studies link coffee drinking to a lowered risk of some types of cancer, including prostate cancer, liver cancer, endometrial cancer, and some cancers of the mouth and throat.

But in some of these studies, the benefit was found in people who drank 4 to 6 cups of coffee a day, which is a lot. Too much caffeine can interfere with sleep, trigger migraines, and cause digestive problems. And if you take your coffee with cream and sugar, the added fat and calories can contribute to weight gain – which increases the risk for many types of cancer. According to Colleen Doyle, MS, RD, American Cancer Society managing director of nutrition and physical activity, the surest steps any of us can take to lower cancer risk are: don’t smoke, eat well, and be physically active.

And if you want to consume more antioxidants, consider adding more vegetables and fruits to your diet. Vegetables and fruits are rich sources of antioxidants, and studies show that people who eat more of them may be helping to lower their cancer risk.

The US Food and Drug Administration (FDA) is alerting women and their medical care providers to the risks of using tests that are marketed as screening tests for ovarian cancer. The FDA says these tests should not be used because they have a high number of false results.

Screening tests look for cancer in people who don’t have any symptoms. For some cancer types, screening tests are available that can find cancer early, when it’s easier to treat. Some tests can even find growths and remove them before they have a chance to turn into cancer. But there are no reliable screening tests yet that can find ovarian cancer.

The FDA has issued a safety communication that warns of risks associated with the use of tests that claim they can screen for ovarian cancer. It says women and their doctors may be misled by the claims and make treatment decisions that rely on inaccurate test results.

Some women may get test results that suggest they have ovarian cancer, even when no cancer is present. This is called a false-positive. This may lead to unneeded medical tests and even surgery, which carry risks. Some women may get test results that say they don’t have ovarian cancer, even though they do. This is called a false-negative. This may prevent women from getting the care they need to treat the cancer.

The safety communication includes a special warning for women with an increased risk for ovarian cancer due to family history or certain gene mutations. The FDA says a test result that shows no cancer doesn’t in fact reduce the risk for these women. They could still develop ovarian cancer in the future. The FDA recommends that medical providers consider referring women at high risk for ovarian cancer to a genetic counselor, gynecological oncologist, or other specialist.

Researchers exploring solutions

A good screening test for ovarian cancer is badly needed because symptoms alone are not reliable indicators of ovarian cancer. Often, symptoms don’t appear until the cancer has spread and it’s harder to treat. And when symptoms do appear, they are usually similar to symptoms of much less serious problems. The most common symptoms are abdominal swelling or bloating, pelvic pressure or abdominal pain, trouble eating or feeling full quickly, and urinary symptoms, such as having to go right away or having to go often.

But so far, no screening test has been shown to lower the number of deaths from ovarian cancer. Two large studies of screening – one in the United States and one in the United Kingdom – found that women who got screening tests did not live longer and were not less likely to die from ovarian cancer.

Researchers are now testing new ways to screen women for ovarian cancer, and a national repository for blood and tissue samples from ovarian cancer patients is being established to aid in these studies.

In the meantime, it’s important for women who have symptoms like those above, especially if they have them almost daily for more than a few weeks, to see a health care professional – preferably a gynecologist.

FDA-approved OVA1 test is not a screening test

Women who have already been found to have an ovarian tumor may receive a test called OVA1. This test has been approved by the FDA, but it is not a screening test. It’s a way to help women and their medical providers predict whether an ovarian tumor is likely to be cancerous, which could in turn affect their treatment.

It has long been known that men with a family history of prostate cancer are at higher risk of getting it themselves. Now researchers from Sweden have calculated just how much having a brother or father with prostate cancer – or both – raises the risk. They also figured out how likely it is that a man with a family history will get a mild or aggressive (fast-growing) type of the disease. The authors suggest their findings can be useful in counseling men who have prostate cancer in the family.

Having more information about the risks of getting an aggressive type of prostate cancer can help men make their own personal decision about testing and treatment.

It seems like it would make sense for everyone to get checked to find out if they have cancer. But screening isn’t perfect. Sometimes screening misses cancer, and sometimes it finds something suspicious that turns out to be harmless. Also, there aren’t reliable tests yet to tell the difference between prostate cancer that’s going to grow so slowly it will never cause a man any problems, and dangerous cancer that will grow quickly. Treatments for prostate cancer can have urinary, bowel, and sexual side effects that may seriously affect a man’s quality of life.

The American Cancer Society recommends that men with a family history of prostate cancer should talk to their doctor at age 40 or 45 about the pros and cons of prostate cancer testing. Because African American men are at higher risk for the disease, they should also have this talk – whether they have a family history or not. Everyone else should begin talking to their doctor about testing at age 50.

Brothers and fathers

The researchers looked at medical records of 52,000 men in Sweden with brothers and fathers who had prostate cancer. They found:

Men with a brother who had prostate cancer had twice as high a risk of being diagnosed as the general population. They had about a 30% risk of being diagnosed before age 75, compared with about 13% among men with no family history.

Men with a brother who had prostate cancer had about a 9% risk of getting an aggressive type of prostate cancer by age 75, compared with about 5% among other men.

Men with both a brother and father with prostate cancer had about 3 times the risk of being diagnosed as the general population. They had about a 48% chance of getting any type of prostate cancer, compared with about 13% among other men.

Men with both a brother and father with prostate cancer had about a 14% chance of getting an aggressive type of prostate cancer by age 75, compared with about 5% among other men.

The researchers found that while the number of close relatives with prostate cancer affected the risk, the type of prostate cancer in the family did not have a strong effect on risk. For example, the risk of an aggressive prostate cancer was just as high in men whose brothers had the mildest form of prostate cancer as those whose brothers had an aggressive type.

While the results of study might provide men with better estimates of their risk when deciding whether to be tested, one note of caution is that the study looked only at men in Sweden. While the results might be similar in other parts of the world where prostate cancer screening rates are fairly high and where people come from similar genetic backgrounds, such as in other parts of northern Europe and North America, it is not clear how well these results would apply among people with different genetic makeups, such as African Americans.

The study was published online July 10, 2016 in the Journal of the National Cancer Institute.

Citation: Family History and Probability of Prostate Cancer, Differentiated by Risk Category: A Nationwide Population-Based Study. Published online July 10, 2016 in the Journal of the National Cancer Institute. First author, Ola Bratt, MD, PhD, Karolinska Institute, Stockholm, Sweden.

The third Tuesday of every September is Take a Loved One for a Checkup Day. It’s a reminder to help a friend, neighbor, or family member visit a health care professional.

According to the US Department of Health and Human Services, many people wait until they have an emergency before going to the doctor. But regular visits to a medical professional can help prevent diseases from occurring or catch them early when they’re easier to treat.

If you know someone you think could benefit from a medical visit, or you are already a caregiver for someone else, ask if they’d like you to go with them to their appointment. Then follow our tips to be as helpful as possible:

Before the visit

Gather their health history information, including current conditions and past surgeries or illnesses.

Gather their family’s health history information, including health conditions of their parents, brothers, and sisters.

Help them make a list of all the medicines they take, including prescription drugs, over-the-counter drugs, supplements, and vitamins.

Update your calendar and bring it to the appointment so you will be prepared to schedule a follow-up visit.

During the visit

Introduce yourself to the doctor or nurse and explain why you are there. Understand if the doctor asks to speak to your friend or family member in private during parts of the visit.

Help your friend or family member go over the list of questions with the doctor or nurse, starting with the most important ones.

Listen carefully to the answers and take notes. If you don’t understand something, ask to have it explained until you do understand.

Help your friend or family member explain their symptoms, health history, and any problems with medicines taken in the past.

Ask follow-up questions during the visit. For example, if medicines are prescribed, ask about the possible side effects. If a test is ordered, ask what it’s for and what the results will tell you. If a specific treatment is recommended, ask if there are any other options to treat the condition and what might be expected from each.

Tell the doctor or nurse if you have concerns about your friend or family member’s ability to follow the treatment plan.

After the visit

Discuss the visit with your friend or family member. If you forget or don’t agree on something, call the doctor’s office and ask.

Ask your friend or family member if they need help filling prescriptions or making appointments for tests, lab work, or follow-up visits.

Call the doctor if your friend or family member has side effects from medications; if their symptoms get worse; or if they start taking any new medications, including prescriptions from another doctor, over-the-counter drugs, supplements, or vitamins.

Remind your friend or family member to call the doctor to get the results of any tests they’ve had or to ask about test results they don’t understand.

The ancient Indian practice of yoga combines meditation, breathing, and precise postures and poses to make a connection with thoughts, body, and spirit. People who practice yoga claim it leads to a state of physical health, relaxation, happiness, peace, and tranquility.

A typical yoga session can last between 20 minutes and an hour. It starts with slow, gentle movements accompanied by slow, deep breaths from the abdomen. A session may also include guided relaxation, meditation, and sometimes visualization. It often ends with the chanting of a meaningful word or phrase, called a mantra, to achieve a deeper state of relaxation. Most people need several sessions a week to improve and to see lasting health effects, but many people report feeling better after just one session.

Group yoga classes can be found in most community and private health centers. No special clothing is required – just wear something that’s comfortable and lets you move freely – although there are many types of clothing that do cater to yoga practitioners.

Also, while yoga is generally low-impact and safe for healthy people, women who are pregnant and people with certain medical conditions like cancer, high blood pressure, glaucoma, and sciatica may have to modify or avoid some poses and should consult their doctor for advice.

Yoga has a low rate of side effects, and the risk of serious injury from yoga is low. However, certain types of stroke as well as pain from nerve damage are among the rare possible side effects of practicing yoga. It’s a good idea to learn yoga from a well-trained instructor, and always a good idea to talk to your health care professional before starting any new exercise plan.

A summary of the findings is being published August 25, 2016 in The New England Journal of Medicine.

BMI and cancer risk

To assess the link between cancer risk and weight, 21 international experts looked at more than 1,000 studies. Most of the studies used body mass index (BMI) to define whether people were overweight or obese.

BMI is a number based on your weight and height. In general, the higher the number, the more body fat a person has. You are considered to be overweight if your BMI is 25 or higher. You are considered to be obese if your BMI is 30 or higher. You can figure out your BMI using an online calculator.

In 2013, an estimated 4.5 million deaths worldwide were caused by overweight and obesity, according to IARC. The identification of new weight-related cancer types will increase the number of deaths attributable to excess weight.

Susan Gapstur, PHD, MPH, American Cancer Society Vice President of epidemiology research, served on the IARC panel of experts. She says there are many ways that excess weight increases cancer risk, which may be different for different types of cancer:

“For example, especially in postmenopausal women, fat cells are an important contributor to sex hormones, such as estrogen, that play a role in the development of endometrial and breast cancer, as well as some other cancers. But there are also other mechanisms that are thought to be important for different types of cancer. These include mechanisms related to abnormal glucose metabolism and excess insulin, altered immune responses, and obesity-related inflammation,” said Gapstur.

For those who are overweight or obese, losing even a small amount of weight has health benefits and is a good place to start.

Citation: Body Fatness and Cancer – Viewpoint of the IARC Working Group. Published August 25, 2016 in The New England Journal of Medicine. First author Béatrice Lauby Secretan, PhD, the International Agency for Research on Cancer, Lyon, France.

The book was written by the experts from the American Cancer Society to help women with breast cancer and their caregivers take their first steps toward understanding a breast cancer diagnosis, making decisions about treatment, and knowing what to expect during recovery.

“When women are diagnosed with breast cancer, they have a lot to think about and a seemingly endless amount of decisions to make. This book supports them by providing a comprehensive and easy-to-understand format to help them navigate through their diagnosis and treatment options, especially during those first days and months,” said Dr. Richard Wender, chief cancer control officer, American Cancer Society.

The book is written in a question and answer format, in plain, easy-to-read language, and includes illustrations that help explain how breast cancer starts and how it affects the body. Additional illustrations help provide details about different types of breast reconstruction.

What’s new in the second edition

Breast Cancer Clear & Simple, Second Edition: All Your Questions Answered has been updated with the latest medical information about how breast cancer is diagnosed and treated. New content includes information about genetic counseling, surgical options, the importance of the lymph system, and what types of breast reconstruction are available.

Updated illustrations provide more helpful information to help women understand their breast cancer diagnosis, and treatment and recovery options.

“This book is an important and innovative tool to support patients with a breast cancer diagnosis to help them make the treatment choices that are right for them,” said Dr. J. Leonard Lichtenfeld, M.D., M.A.C.P., deputy chief medical officer, American Cancer Society.